RawGosia

Is B12 deficiency an honorary raw vegan badge?

“Consumption of ice cream increases during the summer and so does the number of people who drown. Therefore, eating ice cream causes drowning.”
(L.F.)

Summary: This article reports a personal case of B12 deficiency and investigates the nutritional validity of the raw vegan diet in this context. We look at the scientific literature and at popular opinions, and arrive at some surprising findings. This isn’t a stereotypical literature review – we ask curiosity-driven questions and dig deep.

1. Introduction

I began suspecting that I might have B12 deficiency late in 2011. The symptoms that led me to this conclusion were primarily more dramatic than ever glitches of my CPU and a general discomfort. I have always been forgetful, including during my days well before going vegetarian in the 80s, but my forgetfulness got noticeably worse. Furthermore, I observed nerve shocks, white spots on my forearm, low appetite, balance problems, and fatigue, all widely believed to be symptoms of B12 deficiency [1,5,11,19,20,21]. Also, I bruise easily, the veins on my legs are quite visible under the skin and my baby soft hair break easily, and it has always been like this. My vision seems to be blurry, but I have been wearing reading glasses fro quite some time, and so it’s hard to attribute this to the B12 deficiency specifically. The aim of this article, beyond reporting which I believe ought to be done so that others can make an informed choice about their raw food diet, is to investigate a few questions that were on my mind for some time.

2. A personal case

First, a personal report. I decided to take a blood test, the result of which suggested B12 deficiency (at a 134 pmol/L level) and the doctor informed me about the shots. I decided that I am going to assume that I have a B12 deficiency indeed, and see how B12 oral supplementation is going to affect this. For now, I opted for sublingual methyl-cobalamin oral form of B12 (which is considered to be a superior, active form of B12) instead of injections, due to

A number of considerable issues with the second alternative [13,14,16,17,24] (which should be looked at by anyone making a decision about their B12 deficiency treatment), and

Recent scientific studies reporting that oral supplementation (in large doses) is a better and effective option even for those with B12 malabsorption [14,15,22,23,39] (which quashes the basis for a long-held popular belief to the contrary).

In particular, the analysis in [64] suggests that despite that prevalence of the view amongst the hospital doctors that “patients with pernicious anaemia cannot absorb adequate amounts of oral vitamin B12 (cobalamin) and therefore require regular intramuscular injections“, and in spite of “concerns, which have been propagated in standard texts, about unpredictable absorption“, there exist evidence that oral cobalamin in high doses may be as effective as, and perhaps superior to injections. This is because apart from the well-known route of B12 absorption through a transport system that involves the terminal ileum and intrinsic factor, which is believed to be 60% efficient, there exists another transport system that does not depend on these two, which is believed to be 1% efficient, and which was discovered in in the 1950s and 1960s. Specifically, about 1% of a high dose of B12 gets absorbed through that system, which happens to be enough to treat the deficiency effectively.

Also, I made a decision to investigate, intellectually as well as practically, whether my choice of raw vegan diet has been unsound from the nutritional point of view [4,6,7,8,9]. From the ethical point of view I have no doubts about the merits of this choice, see [2,3] for example. It may be a difficult choice between the ethics and health, should eating animals be necessary for optimum human health, as some might argue. So I wonder about the suggested necessity. Hence, the aim of the experiment was to investigate the alternatives and ideas, and in particular, re-examine the validity of my choices. Naturally, one can survive without eating animal products for a very long time, but can we do so indefinitely? Can humans survive without the exploitation of animals altogether?

Modern science clearly recommends B12 supplementation for vegans, and the views that long-term veganism would eventually lead to B12 deficiency and that vegans are at a higher risk than others, seem a standard [14,32,38,54]. My experience has taught me though that science is not always right, and since

“Human nutrition research and practice is plagued by pseudoscience and unsupported opinions” [37],

for the past several years I assumed a position of doubting that advice, and focused on studying the empirical evidence until I could form a more definite opinion. In the recent couple of years, as raw vegan diet became more popular and many people started experimenting with it, some empirical evidence against raw veganism seems to be mounting in the form of reports of health problems [77,78], including B12 deficiency, after embarking on the diet. Yet, at the same time, there exist many incredibly compelling examples in the support of raw vegan lifestyle, and some raw vegans are the most radiant people I have ever seen. Are the looks everything though? We can see beautiful people in all lifestyles, but the beauty is not necessarily parallel with optimal health. For instance, reports of fit-looking athletes dying of heart attacks or getting cancers are not uncommon.

What about the instincts? Could it be that my body truly wants the animal foods but my decision making has been clouded by my ethical beliefs? Has my choice of vegan foods been an incorrect response to its needs? Is meat “a nutritious food” [26] that I should be eating? Have I developed a “vegan tunnel vision” [27] or became “rigid and narrow minded” [50]? I decided to investigate this closely and perform an experiment, because I needed to know the answer to these questions. I am not asking you to agree with my reasons, but I hope that you are open-minded enough to understand the primary drive for me doing so.

Remark: Although MMA is considered by some to be the best test for diagnosing B12 deficiency, “reliance on one test alone courts frequent misdiagnosis” [86]. MMA test is “is not specific enough to provide a firm diagnosis” [88]. The diagnosis “on the basis of serum cbl level alone cannot be considered a reliable approach to investigating suspected vitamin deficiency” [87].

3. Anecdotal evidence speaks

I chose cooked (as I can’t bare the idea of eating raw) eggs as the animal product to test due to their least invasive, in my perception (which I now doubt), nature. Below is the account of what I observed and my conclusions from this experiment. Initially, I have observed a lack of adverse feelings during the meals. On the contrary, I enjoyed my meals. I felt like I was getting something I needed from them. However, after a few times, I started noticing negative side-effects. Specifically, hot flashes, non-existent before, kicked in on daily basis. Furthermore, I noticed a very unpleasant taste and a film of a sticky substance inside my mouth. I recognized this to be the distinct taste of a chicken. Following this, the idea of eating eggs yet again would result in the feeling that I classify as repulsion. I could see myself overcoming it, yet I could not deny that it was there. So I ask,

If veganism is not a nutritionally sound choice,
why does eating animals feel so bad?

Naturally, this is my personal experience, which may not be equivalent to that of others. Some paleo foodists might say that my B12 deficiency can be easily addressed by including animal products in my diet on regular basis, rather than resorting to supplements. If eating animal products was guaranteed to prevent B12 deficiency, why would a friend of mine, who has been eating animal products regularly, have B12 levels as low as mine though? It is well-known that meat eaters are prone to B12 deficiency too, and the statistics from the recent studies may be surprising [45]. In one case, we hear

“I’m your evidence. I eat meat everyday, have done since I was a kid, and at age 29 was diagnosed with extreme B-12 deficiency/pernicious anemia. This after going to a neurologist because they thought I had MS. I have permanent nerve damage as a result of not being diagnosed earlier, a simple test would have prevented this when I first complained to a doc at age 23. If you have any symptoms of deficiency take a test, it’s cheap and simple, as is correcting the issue.” [45]

Furthermore, since one egg supplies about 20% of recommended daily intake of B12, and a moderate consumption of animal products may not be sufficient for restoring B12 levels [49], this would mean lots of eggs as well as hot flashes on daily basis, neither sounding like my favorite thing to go through. While hot flashes are a standard amongst the menopausal women, they are reported to disappear while on a raw vegan diet, and this certainly has been the case for me. Some raw paleo foodists might suggest that perhaps it is the cooked meat that causes them, and that eating raw meat would not have that effect at all. This might make sense, and there exist studies linking cooked meat with cancer, see [57] or the references in [35] for example, which suggests that it may be best to avoid it. Still, somehow, visualizing myself eating raw meat with the aid of wonderful on-line resources [30] appears awfully unappealing to my senses. So, I ask

Why would I posses the body that needs to eat meat,
and, at the same time, senses that feel repulsed by it, as well as the awareness that needs me not to do it?

I realize that this may be only my personal, subjective experience, nevertheless the best I can do is to follow my senses. I tried my hardest to “not give a fuck” [25], but have not really succeeded. Some might argue that I might still be under the influence of some preconceived ideas, well hidden in my sub-conscious mind, and they could well be right. Still, I could equally argue the same about the beliefs about the necessity of meat eating born as the result of their traditional upbringing. However, as there are reported cases of people who suffered significant health deterioration on a raw vegan diet, which they were able to reverse after including the animal products, with some rather astounding visual results [81], it would be hard for me to argue that what currently feels right to one person (me), must be right for everyone else, or even for myself forever.

Some insight-lacking raw vegans like to blame those who have health problems on this diet for not doing it correctly. In my view, if anything, it is following someone’s advice to the letter whilst ignoring the signals of the body, what causes most problems. I believe that a lot more emphasis should be placed on understanding the instincts than following some artificially imposed rules. As a simple example, eating unripe fruit is bound to cause teeth problems in the long term, but this can be easily avoided if a person is paying attention to the taste of the foods. Further, although eating enough is important, it is better to follow the natural instincts than guidance based on calorie calculators that have been rejected by science as fundamentally flawed [28]. Of course, getting educated by reading peer-reviewed scientific articles instead of just on-line articles or popular books, does not hurt either [35]. It is presumptuous to assume that it must be something that a person did or did not do that contributed to their health issue. There exist factors beyond our control too, such as genetic factors. B12 deficiency may be caused by a person’s predisposed absorption problems that cannot be fixed even by the healthiest lifestyle on Earth [29].

What could have caused my B12 deficiency? I have never tested for B12 deficiency before, and since I had memory problems, as well as ease of bruising, enlarged veins and weak hair, long before I went raw, it is possible that I had it already, and it only got worse recently. In fact, this would explain many embarrassing situations in the past. Do I have some undiagnosed genetic disorder? Many autistic children have B12 deficiency [31], and my son has Autism spectrum disorder, which suggests that a genetic factor may be a possibility. Was there anything that would explain the recent worsening of the symptoms? Last year has been a difficult year. After the death of my son’s father, a troubled man I had left many years ago, the colors of what I wear shifted from vibrant to black. The recent period in my work has been quite exhausting too, with a lot of new commitments on my shoulders. I have been finding it hard to find some quiet time for myself.

4. A larger picture

The list of possible causes of B12 deficiency in a recent review by Moore et al. [42], amongst several factors, includes inadequate dietary intake and vegetarians are singled out as a related risk group. Yet, according to an opinion by Vivian V. Vetrano, a chiropractor with a degree in Homeopathic Medicine, and a former manager of Herbert Shelton’s Health School,

“There is no such thing as a B12 deficiency, even in 100% raw vegan food eaters. They do not have to eat dirt, animal products, or take pills to secure coenzymes of B12. Bacteria in the intestinal tract make it for us, and the metabolically usable and necessary forms of coenzyme B12 are contained in unprocessed, fresh natural plant foods, particularly in nuts and seeds. The real problem in so-called B12 deficiency is a failure of digestion and absorption of foods, rather than a deficiency of the vitamin itself.”

“Furthermore, absorption of the natural B12 coenzymes can take place in the mouth, throat, esophagus, bronchial tubes and even in the upper small intestines, as well as all along the intestinal tract. THIS DOES NOT INVOLVE THE COMPLEX ENZYME MECHANISM FOR ABSORPTION (INTRINSIC FACTOR) IN THE SMALL INTESTINE AS REQUIRED BY CYANOCOBALAMIN. THE COENZYMES ARE ABSORBED BY DIFFUSION FROM MUCOUS MEMBRANES. ” [34]

However, Jack Norris, a Registered Dietitian with a degree in Nutrition and Dietetics, says that the article by Vetrano is “one of the most fanciful stories I’ve ever read about vitamin B12” [36], and comments:

“Many vegans are understandably skeptical of the medical and scientific community. But by refusing to accept the scientific evidence in favor of the need to supplement with B12, we provide a steady flow of vegans with health issues for the medical community to study.”

“All vegan advocates should be aware of the symptoms of B12 deficiency (with the realization that elevated homocysteine levels occur long before these symptoms are noticeable), and the need for new vegans to start supplementing with B12 shortly after becoming vegan (or even near-vegan).” [33]

After observing the raw vegan movement for a number of years, studying various real-life cases, mine amongst them, and reading a number of scientific reports, I can’t deny that it appears that Jack Norris’s advice is well justified. Nevertheless, I am not convinced that Vetrano’s insights about malabsorption aren’t interesting, although malabsorption clearly is not the only cause of B12 deficiency [42].

Is routine, ‘just in case’ supplementation a good idea anyway? Perhaps not so. According to a 2012 study reported in [63],

“With the possible exceptions of Vitamin D and omega-3 fatty acids there is no data to support the widespread use of dietary supplements in Westernized populations; indeed, many of these supplements may be harmful.”

Or, according to [62],

“Treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods.”

Should this be an invitation to ignoring the issue then? Definitely not.

“Patients must learn about B12: It can become low regardless of diet. A surprising percentage of physicians still believe information that was debunked by accepted research decades ago. Missed or delayed diagnosis and/or treatment can result in slowly or rapidly developing disability, and death.” [82]

Interestingly, a study in [40] suggests that

“there may be a casual relationship between H pylori and food-cobalamin malabsorption“,

and [42] lists gastritis as one of the causes of B12 deficiency with H. Pylori infection as one of the risk groups, thus directly linking B12 deficiency with the health of our internal environment, just as Vetrano does.

“Humans have been colonized by Helicobacter pylori for at least 50,000 years and probably throughout their evolution” [41].

Deterioration of health with age, drug use, or Crohn’s disease are other factors linked with B12 deficiency [42], all also corresponding to our internal health. Raw vegan diet is reported to dramatically improve our internal health and address these problems, and it is not a surprise that raw vegans believe it to be the best dietary and lifestyle choice for humans. Is it though? A study in [48] reports that

“uncooked extreme vegan diet causes a decrease in bacterial enzymes and certain toxic products that have been implicated in colon cancer risk“.

So I ask,

Why would following an optimum diet inevitably lead to B12 deficiency?

Is the assumption of it being optimal incorrect then? Understanding the difference between the optimum and the ideal is crucial here. The ideal diet may be a fruit-based raw vegan diet made of freshly-picked foods from a bush or a tree in our wild environment. This is not going to happen in real life for the majority of raw vegans. The optimum diet is the best we can get in the circumstances we are. So, what is our optimum diet? And, is it necessarily exactly the same for everyone? I personally doubt this, and my view, supported by current literature [83, 84], is that human diet is naturally very diverse, because we come from diverse environments and backgrounds, and that with this geographical diversity comes a deeper diversity of what is natural, or perhaps optimal to different people. Perhaps some core concepts may be the same nevertheless. In particular, the results of several independent studies suggest that significantly increasing the amount of plants in our diet, might be a good idea [35]. What about the meat?

5. Searching for a good cause

Randomized control studies (RCTs) are considered to provide a higher level of confidence in claims about causation than case or cohort studies, but they are often not feasible due to high costs, the length of time required for their execution or ethical concerns. Moreover, they cannot really prove the causality, as rigorous proofs exist only in hard-core sciences, Mathematics. So, in the end, the best one can do is to decide to have a conviction in what the studies suggest, or not. What helps in making up one’s mind is the explanation of the causal mechanisms and the evidence to back it up. For example, there is a strong association between smoking cigarettes and cancer as well as the evidence of mechanisms involving carcinogenic toxins that cigarettes contain, and so it is well-justified to assume that smoking cigarettes is not a great idea.

As another example, while “randomized controlled trials on red and processed meats and colorectal cancer are considered not feasible“, multiple independent studies strongly suggest an association (e.g. see references in [35]), for instance

“The accumulated evidence from prospective studies supports that red and processed meats intake is associated with increased risk of colorectal, colon, and rectal cancers. The risk increase in colorectal cancer estimated in linear dose-response models was 14% for every 100 g/day increase of total red and processed meats, 25% in colon cancer, and 31% in rectal cancer” [70],

and there also exist independent recent studies that offer the explanation for the underlying mechanisms (e.g. [71-75]), which suggest carcinogenic compounds generated during meat cooking [71] or bovine infection in the consumption of undercooked beef [72], as examples. There exists also a critique of some studies [80] and further, association does not prove the causation, nevertheless, until we know the full picture, it seems reasonable to be careful for the sake of personal safety.

Therefore, although a formal proof may not be available, it makes sense to leave the red meat, cooked or raw, out and be on the safe side.

Some paleo foodists strongly disagree with this, and argue that the science behind the claims of red meat being unhealthy is deeply flawed [85]. I admit that I would like to look at this issue more closely, and examine the validity of the arguments on both sides of the fence, but due to time and space limitations, will postpone this for another project. Some of the views underlying the arguments against eating meat may not have a solid scientific basis indeed. According to [79],

“Given the large social impact of dietary advice, it is important that the advice have a solid scientific basis.”

but

“Results and conclusions about saturated fat intake in relation to cardiovascular disease, from leading advisory committees, do not reflect the available scientific literature.”

Of course, we should mention here that meat is not guaranteed to be the best source of B12 anyway. According to [59],

“In relation to the bioavailability of vitamin B12 food sources, meat was shown to be inferior to other foods, such as milk.”

Note also that

“The percent bioavailability is inversely proportional to the dose consumed due to saturation of the active absorption process, even within the range of usual intake from foods.” [58]

Now, the questions that I am really interested in are:

Does veganism cause B12 deficiency?

Does low B12 cause cognitive decline?

According to Moore et al. [42],

“High folate and low vitamin B12 levels may be associated with cognitive impairment“.

A raw vegan diet that is rich in greens would provide high levels of folate, as greens are known to be an excellent source of if. If such raw vegan diet does not provide much B12 though, as science suggests, does it mean that green-loving raw vegans could be at a greater risk of a cognitive impairment than fruitarians?

Before we get excited about such suggestions, note the words “may be” in the above quote. It is much easier to find an association between some factors, than prove that one causes another. Moore et al. [42] emphasize:

“Having established the association of vitamin B12 insufficiency with neurodegenerative disease, the challenge is to discern the direction, if any, of causation. Most neurological impairments present a slow, progressive course (Josephs et al., 2009) and vitamin B12 levels may take a number of years to deplete (Herbert, 1998). Studies investigating causation would need to continue over an extended period of time.”

The authors suggest that

“any association may simply be coincident or the factors predisposing patients for neurodegenerative disease may simply also expose the patient to a higher risk of vitamin B12 deficiency”

and conclude that

“Further intervention studies in large samples followed over an extended period of time are required. This will allow for further investigation of the role, if any, of vitamin B12 in the onset or progression of neurodegenerative disease, as well as the latent period of effect of vitamin B12 insufficiency before cognitive deficits are evident.”

That is, contrary to a popular belief that undoubtedly fuels a lot of fear amongst vegetarians, to date

there is no evidence that low B12 causes cognitive decline, and the scientists are not convinced that it must be low B12 that causes it.

Furthermore, the authors mention studies of vitamin B12 deficient at a level below 200 pmol/L but otherwise healthy individuals, with no history of dementia, which “failed to detect any benefit from using vitamin B12 with or without folate” for them. One of the quoted studies [44] concludes that

“Oral supplementation with vitamin B-12 alone or in combination with folic acid for 24 wk does not improve cognitive function“.

Significantly, from these studies it appears that B12 levels below 200 pmol/L are not a guarantee of ill health. Is it possible that what is perceived as B12 ‘deficiency’ (insufficient level of, that is bound to cause health problems), may not be a deficiency at all? Could the levels at which a person becomes B12 deficient be different for different individuals? Also, when we observe the B12 deficiency symptoms, are these possibly symptoms of some other underlying cause? It is well-known that long-term vegans, including raw vegans, can have low B12 levels [47,51-54]. Is it possible that those vegetarians that are classified as B12 deficient in various studies,

Could not be B12 deficient at all (and simply have levels that fall within the ‘deficiency’ category), or

When they have a genuine health problem, it is caused by some other than dietary factor?

In 1999, a study of 36 long-term vegans reported that “Most of the vegans had vitamin B12 values less than 200 pg/ml” and “None of the vegans had any hematologic evidence of vitamin B12 deficiency, however four of them had neurologic complaints” [46]. That is, out of the 36 tested individuals, 4 had detectable symptoms but 32 did not. How does the statistics of (roughly) 10% of those that did have symptoms compares to the statistics of the general population? In another study, “One vegan of 5 years had no symptoms of B12 deficiency despite a sB12 of 90 pg/ml. However, after 1 month of oral B12, he noticed that his chronic indigestion after meals had disappeared” [47].

Additionally, according to the study in [66], in which children with adequate or inadequate dietary vitamin B12 intake were compared,

“Dietary vitamin B12 intake was inadequate in 43% of children; these children were poorer, had less frequent diarrhea, and obtained a higher percentage of their energy from carbohydrate than children with adequate intake. Energy intake positively predicted dietary vitamin B12 intake. In contrast, serum vitamin B12 concentrations were normal in all but 3% of the children. Serum vitamin B12 was positively associated with weekly servings of fruit, corn-based food, and ñame (a traditional starchy food), but not with animal-source foods. Finally, serum vitamin B12 was not associated with Ascaris intensity but was lowered with increasing frequency of diarrhea. Conclusions. Although inadequate dietary intake of vitamin B 12 was common, most serum values were normal. Nevertheless, diarrheal disease emerged as a negative predictor of serum vitamin B12 concentration.”

When can we be certain that a low B12 level is a definite sign of a serious disorder? The reality is that certainty is not something that empirical science, whose findings involve probabilities, can deliver. For the sake of the personal safety, it is better to assume the worst, since

“false positives (believing there is a connection between A and B when there is not) are usually harmless, whereas false negatives (believing there is no connection between A and B when there is) may take you out of the gene pool” .

However, for the sake of the intellectual enlightenment and scientific accuracy, it is useful to be aware of the limitations and follow the scientific developments as they unfold, without jumping to conclusions.

“If an experiment agrees with a theory it means for the latter Maybe, and if it does not agree it means No.” (Einstein)

Unfortunately, there exist many on-line articles that misrepresent the view of the literature. Google “B12 deficiency causes neurological” and we get 47,800 hits. Google “B12 deficiency is associated with neurological” and we get only 4. An example is the article at [43], whose author states

“We know that B12 deficiency causes neurological disorders, that is in every textbook; several of the abstracts I linked to are simply case reports exemplifying the fact.”

Had the author, who admits that he often doesn’t have an access to the full articles and hence relies on abstracts, opened the articles and noted the difference between the association and causality, such misrepresentation would have been avoided. Should we be surprised by the scale of this phenomenon? As an example, the authors of one nutrition textbook [55], hailed as

“America’s Most Trusted Source of Information on Prescription and Over-the-Counter Drugs“,

state that

“The mechanism by which B12 deficiency causes neurological effects and by which B12 administration may reverse them is not well understood.” [82]

“Unfortunately, many editors of medical reference materials have not updated their B12 information for many years to decades. Thus, even a doctor who cares enough to check will likely be misled or worse.” [82]

6. Dig deep

“Not everything that can be counted counts, and not everything that counts can be counted.” (Einstein)

According to the study in[65], B12 produced in human colon is unavailable “to the non-coprophagic individual“,

“However, the human small intestine also often harbours a considerable microflora and this is even more extensive in apparently healthy southern Indian subjects. We now show that at least two groups of organisms in the small bowel, Pseudomonas and Klebsiella sp., may synthesise significant amounts of the vitamin.”

Next, a study of Asian Indians [67] reports that about 75% of the subjects, both vegetarians and non-vegetarians (with only one strict vegan), had metabolic signs of cobalamin deficiency. Significantly, the authors suggest that

“Marked ethnic differences in cobalamin metabolism have been reported (40); therefore, the possibility that Indians have adapted to a chronic low cobalamin concentrations through genetic mechanisms should be considered.”

Thus, there exist differences in B12 absorption amongst different people, which may be caused by genetic factors beyond the control of an individual.

Moreover, the authors conclude

“This finding agrees with our observation that even subjects with relatively high cobalamin concentrations can have high tHcy and MMA concentrations. Notably, in the study by Lindenbaum et al, the high MMA concentration was related to anaerobic gut flora and the high tHcy concentration was explained by a low cobalamin concentration. Some studies suggest that overgrowth of intestinal bacterial may lead to formation and absorption of inactive cobalamin analogues (42, 43).”

That is, high B12 levels is not the guarantee of lack of problems, and a connection has been made, again, with the internal health.

In [68], Virginia Vetrano reports a case of a woman who despite B12 injections, suffered from vitamin B12 deficiency-based pernicious anemia,whose anemia disappeared after fasting, and mentions over 100 fasts supervised by Dr. William Howard Hay in which all but eight patients had their anemia subside.

One blogger comments [76]:

“How can this be? During a fast one is taking in nothing but water, and so it can’t be that suddenly the patients get “enough” B12 for their symptoms to subside. There are only a few possibilities:

The proper B12 levels were there all the time but body conditions brought on by high-fat substandard diets and poor lifestyles stopped them from being utilized properly.

The patients had declined to the point where their body was no longer capable of using or producing B12, but the fast allowed them that ability to recover.

All three of these possibilities causes problems for the typical “you need more” treatment of vitamin B12 deficiency the majority of doctors and nutritionists adhere to. If the answer isn’t more B12, then what is it?”

According to [69], plants grown with organic fertilizers often contain higher concentrations of vitamin B12 than plants grown with inorganic fertilizers. Could

be contributing to this in some way? Could these health problems be the price that humanity pays for removing itself from the natural environment?

7. Conclusions

Raw vegans as well as other suspected risk groups, in particular those with compromised internal health, may benefit from supplementing their B12 intake.

Anyone, vegan or not, with the symptoms of B12 deficiency should consider contacting a registered health professional.

Oral supplementation in high doses seems an effective treatment.

Moderate meat consumption is not guaranteed to fix B12 deficiency and high meat consumption is not guaranteed to prevent it.

B12 levels below 200 pmo/L are not a guarantee of ill health.

The levels at which one is B12 deficient may vary for each individual.

There is no evidence that B12 insufficiency causes cognitive decline, and there may be some other underlying factors with which B12 is associated.

The results of several independent studies suggest that significantly increasing the consumption of plants and removing red meat from our diet seems a good idea.

There is a lot that we do not know about B12.

My personal decision between eating meat or supplementing, is to choose the latter, for now. I am open to short-term experimentation in order to learn, re-examine ideas, and possibly rid myself of the common curse of vegan self-righteousness at the same time, but not to repeating the old mistakes. My recommendation to others is to not let fear or peer pressure drive you, but to get educated and to follow your own heart. I think that the combination of both is the most sensible choice. Relying on either of those solely is not a good idea, as neither offers a guarantee of infallibility. Further, allow yourself to evolve and adapt, as

“No one answer is permanent, and no one answer is universal” [56].

Using one’s instincts as a guidance that offers far more powerful properties than limited models can ever do, the intuition that is the door to developments that mere rigor cannot offer, and the critical thought of the intellect that can cushion against gullibility, is an approach that I classify as optimum.

Above all, do not rely on the advice of self-promoting, uneducated on-line gurus, but rather, contact a specialist. Your health is too precious to place it in the hands of quacks. Not looking after it, is unethical too.